Image from page 539 of “The American text-book of obstetrics for practitioners and students” (1903)

Childbirth is so much more than the beautiful, idyllic, dream come true wonderland of perfection and sweetness everyone tells you it will be. When all goes well, after nine months and a grueling labor you get a beautiful bundle of amazing and a body that feels like it’s trying to revenge murder you for doing such unspeakable things to it.

Any woman who alleges that the postpartum period is breezy and beautiful, even in the best of circumstances, is probably a compulsive liar or a movie star with four personal assistants and a full time nanny and housekeeper. This great article about postpartum practices in the United States covers that subject very well. My real troubles began to surface well after the first couple of months postpartum.

I was counting the hours until I was allowed to head back to Zumba classes. It was great to get back out in the world. I took things slow at first and thought I would gradually build my strength and endurance back up to where it was before. As I wrote in a previous post, I was yawning a lot more, sometimes all the way through class, but fatigue is par for the course with a newborn.

Four months after my son Ulysse was born, I probably would have been back to my old self if it weren’t for the constant nagging feeling that if I even thought about jumping one more time I was gonna pee myself. I always wore black pants just in case and continued to have to use the restroom in the middle of class like when I was eight and a half months pregnant. Something had to be wrong.

Meanwhile, back at physical therapy, Carl couldn’t find anything else apparent to do to resolve the low back pain I’d been whining about for weeks. He suggested blood work to rule out vitamin and mineral deficiencies that might be the culprits. I immediately whipped out the recent lab results from the blood work I’d had done after an unfortunate episode in which I had fainted and bashed my face on the edge of the crib. Nothing suspicious. That’s when Carl got a slightly pained look and, for a guy who is not shy about much, hesitantly inquired about any “other” symptoms I might be having, such as, say…urinary incontinence?

Is there anything more embarrassing to discuss in polite company than urinary incontinence? I mean, I don’t have statistics or anything, but I feel like genital warts are probably less stigmatizing and anxiety producing. No one will ever find out you have genital warts if you sneeze, cough or laugh too hard without crossing your legs. But with this terrible, and yet highly curable affliction, ANY sudden, wrong move could result in social tragedy.

Let’s just agree to call this wretched malady by its less threatening, fancy medical name, “pelvic floor dysfunction,” so I can stop sweating and avoiding eye contact with my screen as I type this confessional.

Below is a helpful, if incomprehensible diagram of all the muscles hiding in your pelvic floor. I imagine my pelvic floor looked a lot like this, but bumpy with big angry knots, flashing red lights and a sign that reads: OUT OF ORDER!!!

According to this terrifying, yet informative article, “pelvic floor dysfunction affects almost 50% of women following childbirth.” What?!? So, why don’t we hear more about it? Like in conversation? With other women. Or OB/GYNs at annual checkups? I brought the subject up at mine and was applauded for my initiative, but no one had ever thought to ask me if I felt comfortable walking briskly down a hill or doing jumping jacks without fear of the dribbles. I’ve heard the occasional joke here and there, but it’s almost always the fatalistic “well, that’s just the way it is now that childbirth has destroyed my body forever…I shall never frolic again.” But it doesn’t have to be like that! As the article mentions, there are varying degrees of PFD and also varying causes, most of which are entirely treatable. The author, a doctor, naturally suggests doing the eternally beloved Kegel exercises and gives directives for OBs (such as performing C-sections?!?!!!!,) but surgery is the only other solution listed that can sometimes work. Sometimes.

Physical therapy is not even mentioned in the article! Nor are apparatuses such as the InTone or Apex pelvic floor exercisers (kind of reminiscent of the abdominal muscle stimulators you wear while you watch TV and magically get abs of steel.) But seriously, all of my friends in France go to postpartum pelvic floor rehab sessions to get back in shape with the help of a trained professional – and it’s all part of routine postpartum care that is covered by their legendary socialized healthcare system! It’s as if they somehow know that most women will have problems with pelvic floor muscle weakness at some time in their lives. Huh.

So, my pelvic floor was a little saggy. Not a surprise after the long labor and 90 minute pushing extravaganza that resulted in a 9 lb. 6 oz. baby with an enormous and perfectly spherical head. Carl happily referred me to another PT specializing in women’s health and let out a sigh of relief that he would not have to go there with me. He’s trained to do it, but neither one of us wanted to take our therapist/patient relationship to that level after six lovely years of playful banter interspersed with excruciating pointy elbow and thumb jabs to my other dysfunctional (non-private) parts.

Enter Laura, a PT specializing in women’s health. She confirmed Carl’s suspicions and began working to ease the tension in the tightly wound trigger points I’d been nurturing for months in what was left of my pelvic floor muscles. Begin the Kegels! But this time with muscles that were re-learning to obey my commands, such as: “No, I do not want to pee now! I’m at Zumba!”

In case you haven’t figured out from my veiled references to what this kind of therapy entails exactly…well, it happens on the inside. Good thing Laura is such a pleasant conversationalist. I am always very curious about the little known facts of different professions and I have never specifically asked her, but I suspect that if she wasn’t already a naturally talkative person, her job has forced her to develop diversion tactics for taking patients’ minds off the bizarre nature of their interaction. How often do you lie in a small, poorly lit room with someone for 45 minutes, naked from the waist down (except for a sheet) while another person probes and massages your nether regions? I bet if you said: “Very often, as a matter of fact!” chances are you weren’t talking about a medical/therapeutic procedure.

There are a growing number of PTs specializing in women’s health out there, but not enough. Laura is in high demand and that’s just for the people who are lucky enough to find out that she just might be able to help solve their problems (men can have PFD too).

In a sad and improbable turn of events, I have recently returned to see Laura again because an ankle injury, of all things, seems to have led my pelvic floor to get bent out of shape again. Things just weren’t quite right and I hoped against hope that it wasn’t because the 40,000 Kegels I was doing everyday somehow weren’t enough. The trigger points were back, but now they are fading once more into obscurity, at least that is my plan for them.

All that to say that yes, childbirth is about as close to a miracle as you can get. But this is one of those “nobody told me” things that can and does happen to lots and lots of women, too.

The human body is a strange and wondrous organism. It can form brand new human bodies and, when injured, it finds ingenious new ways to keep going anyway. There are limits, however, to what our bodies will tolerate before the pain kicks in. That’s when I run, or limp, to the nearest PT. Calming the grumpy fascia in my calves can make my neck feel better and unjamming my ankle can relieve the opposite hip, too. I seem to be especially prone to frequent inexplicable injury, but the upshot is that as the kinks get worked out one by one, I get a glimpse of how everything really is connected in this incredible microcosm of the universe – my body.

Well, you had me laughing out loud at the image of chatting with your internal PT whilst being probed, but I am sorry you have had to go through this. You’re right, this should be talked about more – I didn’t know it affected women right after giving birth. My sister-in-law had to have surgery for it, but she’s in her 60’s. She probably suffered for years without knowing what could be done. You know, I wonder if it’s just us women who have very bizarre interactions with their doctors during exams. Mine has told me about his charity work in Ecuador while in the middle of the annual Pap smear. I mean, it’s interesting, but just downright odd. Anyway, I digress. I hope you are feeling better & that this is clearing up. Sounds like France has the right idea.

Great article, Gina! Such elegant prose for such an in-elegant topic :-)… You know, it’s funny that we have never talked about this, but I’ve had similar issues. In addition to PFD, I have DR (Diastasis Recti), a separation of the recti muscles of my stomach. These issues, as you can imagine, are interconnected. I have also been working on them, but for some reason I have not been to a PT. I was hoping that getting “adjusted” at the chiropractor might do the trick, but it has not so far. As you mentioned, it is a mystery why women in this country are not told about this… In any case, my next step is to get in touch with a PT that specializes in pelvic floor. We should compare notes and approaches, next time we see each other.

Maria, thanks for reading! I am so sorry we have this scourge in common…i am so glad you are going to go see a PT. I was trying to do all the right things, but with the trigger points keeping my muscles from doing their job properly, nothing was happening. So frustrating. I can’t wait to hear all the (hopefully not too) gruesome details! 😉

I think there are a lot of reasons things can go wrong in the pelvic floor – I know I read that the older you are, the more likely you are to get pelvic floor trauma, or worse or something, for childbirth. Injuries and surgeries are other reasons, and aging makes sense too…and since men can also have these probs, I guess you don’t have to have a baby to suffer 😦 Kegel forever!